OFSCDRS 2013

Following a partial settlement of the applicant's claims for statutory accident benefits, the parties could not agree on the quantum of expenses payable by the insurer.

The arbitrator assessed the applicant's legal fees and disbursements, reducing the claimed hours and applying a 40% reduction to account for work related to unsettled issues.

The arbitrator awarded $14,140.18 in expenses but allowed the insurer to set off $1,000 previously ordered against the applicant for a late disclosure adjournment, resulting in a net award of $13,140.18.

The applicant's representative brought a motion to be removed as solicitor of record due to a complete breakdown in the solicitor-client relationship, citing the applicant's failure to respond to numerous communications and attend scheduled pre-hearings.

The arbitrator granted the motion, finding that the representative had complied with the Dispute Resolution Practice Code requirements for withdrawal.

The applicant was injured in a motor vehicle accident and applied for income replacement benefits from his automobile insurer.

He was also receiving $2,000 per month in disability benefits from a Manulife personal accident disability insurance policy.

The insurer argued these benefits were deductible as payments for loss of income under an income continuation benefit plan pursuant to the Statutory Accident Benefits Schedule.

The arbitrator found that the Manulife policy required the applicant to be employed at its inception and that the maximum benefit was calculated with reference to his income from employment.

Consequently, the Manulife benefits constituted payments under an income continuation benefit plan and were deductible from the applicant's income replacement benefits.

The applicant applied for arbitration regarding statutory accident benefits following a motor vehicle accident.

The applicant failed to appear at the pre-hearing and the scheduled arbitration hearing, and had not communicated with his counsel or the Commission for months.

Counsel's request to be removed from the record was granted.

The insurer's request to dismiss the arbitration on a without costs basis was granted due to the applicant's failure to appear and provide instructions.

The applicant applied for statutory accident benefits following a motor vehicle accident.

After his legal representative withdrew due to a breakdown in the relationship, the applicant failed to attend pre-hearing discussions and the scheduled arbitration hearing.

The arbitrator proceeded in the applicant's absence and dismissed the application for arbitration, awarding $1,500 in expenses to the insurer.

The applicants sought statutory accident benefits following a reported motor vehicle collision.

The insurer terminated benefits and sought repayment, alleging the collision did not occur as reported.

At a preliminary issue hearing, the arbitrator weighed competing accident reconstruction expert evidence and the applicants' testimony.

Finding the applicants' evidence credible and the applicant's expert persuasive, the arbitrator concluded on a balance of probabilities that the applicants were involved in an 'accident' as defined in section 2(1) of the Schedule.

The applicant was injured in a motor vehicle accident and applied for medical and non-earner benefits.

The insurer refused to pay for medical benefits because the applicant failed to attend insurer's examinations to determine if her injuries fell within the Minor Injury Guideline, and argued this precluded her from mediating the refusal.

The insurer also refused to pay a non-earner benefit, arguing she did not apply for it.

The arbitrator held that the insurer's notices did not comply with the Statutory Accident Benefits Schedule, so the applicant was not precluded from mediating her medical benefits claim.

The arbitrator also found the applicant was not precluded from pursuing her non-earner benefit claim, as her initial application and disability certificate triggered the insurer's obligation to determine continuing entitlement.

The insurer was ordered to pay the claimed treatment expenses.

The Applicant sustained a catastrophic brain injury in a 2008 motor vehicle accident.

She sought attendant care benefits of $6,000 per month and housekeeping benefits of $100 per week.

The Arbitrator found that the Applicant reasonably required 24-hour basic supervisory care due to her inability to respond to emergencies and changes in behaviour, awarding $6,000 per month from April 14, 2009 onwards.

The claim for housekeeping benefits was dismissed because the Applicant failed to prove her pre-accident housekeeping activities and failed to provide the Insurer with reasonably requested particulars about the services provided.

The applicant was injured in a motor vehicle accident in August 2005.

Nine months later, she suffered severe disc herniations resulting in a cauda equina-like syndrome and a conversion disorder.

The insurer denied ongoing income replacement and attendant care benefits, arguing the disc herniations were not causally related to the accident.

The arbitrator found that the accident materially contributed to the disc herniations and the subsequent conversion disorder.

However, the arbitrator concluded the applicant was not catastrophically impaired, as her combined physical (21%) and mental/behavioural (28%) whole person impairment rating was 43%, falling short of the 55% threshold.

The applicant was awarded an ongoing income replacement benefit and attendant care benefits capped at $3,000 per month for the 104-week period following the accident.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits from his insurer, including income replacement, attendant care, housekeeping, medical benefits, and the cost of examinations.

The insurer had terminated income replacement benefits on the basis of non-compliance with a work-hardening program.

The arbitrator found that the applicant had participated in the program and that his severe back injuries and chronic pain rendered him completely incapable of engaging in suitable alternative employment.

The arbitrator awarded ongoing income replacement benefits, partial attendant care and housekeeping benefits, the requested medical benefits and examinations, and interest.

Furthermore, the arbitrator ordered the insurer to pay a maximum special award of 50% for unreasonably withholding income replacement benefits after receiving evidence of the applicant's compliance with rehabilitation.

The applicant failed to attend a preliminary issue hearing regarding whether she was involved in a motor vehicle accident.

Her counsel appeared to request removal from the record due to a loss of communication, noting that the applicant had failed to complete settlement documents and her contact numbers were disconnected.

The arbitrator granted counsel's request to be removed.

The insurer requested that the arbitration be dismissed with expenses.

Given the applicant's failure to attend or communicate, the arbitrator dismissed the application for arbitration and ordered the applicant to pay the insurer's expenses fixed at $1,500.

The applicant dismissed his counsel during a teleconference and requested an adjournment of the scheduled hearing.

The insurer objected and sought costs thrown away against the former counsel personally, or alternatively against the applicant, arguing the proceeding was commenced without authority or was frivolous.

The arbitrator dismissed the motion for costs, finding no evidence that the application was commenced without authority or that it was frivolous, as the matter had not yet been adjudicated on the merits.

The arbitrator also found no evidence that any preparation costs were actually thrown away.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer denied non-earner and housekeeping benefits, but subsequently sent a letter indicating it was reviewing the applicant's entitlement, which the arbitrator found rendered the initial refusal invalid and estopped the insurer from relying on the limitation period.

The arbitrator also found that the applicant was not precluded from proceeding to mediation for a treatment plan despite failing to cooperate with insurer's examinations, as the relevant provision of the Schedule applied to designated assessments, not insurer's examinations.

The Appellant appealed an arbitrator's expense decision following a statutory accident benefits arbitration.

The arbitrator had awarded the Appellant reduced legal fees based on a 1:1 preparation-to-hearing ratio due to his modest success, and had also significantly reduced the Appellant's claimed disbursements without giving the Appellant an opportunity to respond to the arbitrator's specific concerns.

The Director's Delegate upheld the reduction in legal fees as a valid exercise of discretion.

However, the Delegate found that the arbitrator's process for determining disbursements denied the Appellant procedural fairness, as the Appellant was not given a chance to provide supporting documentation or submissions addressing the arbitrator's concerns.

The disbursement portion of the order was rescinded and remitted for a new hearing.

The insurer brought a motion to compel the applicant to produce certain documents and for third-party production orders under Rule 67 of the Dispute Resolution Practice Code.

The insurer also requested relief, including dismissal or a stay of the arbitration, due to the applicant's refusal to attend insurer examinations.

The arbitrator declined to address the non-attendance issue, finding it was not properly before her on a productions motion and should be determined by the hearing arbitrator.

The arbitrator ordered the applicant to produce employment and income records, ordered the insurer to produce its adjusting file, and granted third-party production orders for clinical, employment, and collateral benefits files.

The arbitrator also ordered counsel to personally bear the costs of their unnecessary correspondence.

The insurer brought a motion to compel the applicant to produce certain documents and for third-party production orders, as well as relief for the applicant's failure to attend Insurer Examinations (IEs).

The arbitrator ordered the production of various relevant documents, including medical and employment records, and initiated the process for third-party production orders.

However, the arbitrator declined to address the applicant's non-attendance at IEs, deferring that issue to the hearing arbitrator to ensure procedural fairness.

The arbitrator also ordered both counsel to personally bear their own costs for unnecessary correspondence.

The applicant applied for statutory accident benefits following a motor vehicle accident.

After failing to attend a pre-hearing conference and losing his legal representative, the applicant also failed to attend the scheduled arbitration hearing.

The arbitrator dismissed the application due to the lack of evidence and failure to pursue the claim, and ordered the applicant to pay $750 in expenses to the insurer.

The applicant applied for statutory accident benefits following a motor vehicle accident.

After failing to attend a pre-hearing discussion and the subsequent arbitration hearing, the applicant's counsel withdrew from the record, citing an inability to contact the applicant who had reportedly left the country.

As the applicant bore the burden of proof and presented no evidence, the insurer's request to dismiss the application was granted.

The applicant was ordered to pay $500 in expenses to the insurer.

The applicant's legal representatives, Bergel, Magence LLP and Andrew Bergel, brought a motion to be removed as solicitors of record due to a material breakdown in the solicitor-client relationship.

The applicant had repeatedly failed to provide requested materials necessary to proceed with her statutory accident benefits claim.

The arbitrator found that the representatives had complied with the Dispute Resolution Practice Code requirements for withdrawal and granted the motion.

The applicant's legal representatives brought a motion to be removed as solicitors of record due to a material breakdown in the solicitor-client relationship.

The applicant had repeatedly failed to provide necessary information requested by his counsel.

The arbitrator found that the representatives had complied with the Dispute Resolution Practice Code and granted the motion to withdraw.